Every 20 seconds someone dies from tuberculosis. But health advocates and experts are hoping a recently announced reduction in the cost of tuberculosis testing could change that.
On Tuesday, several organizations specializing in tuberculosis announced a major victory: The multinational Danaher reduced the cost of crucial tests for tuberculosis infection and resistance to a commonly used drug by 20 percent.
“This is the first time in more than 13 years that the cost of testing has been reduced,” said Stijn Deborggraeve, diagnostic advisor for the Doctors Without Borders access campaign.
According to a press release announcing the Global Fund to Fight AIDS, Tuberculosis and Malaria, “this lower price will enable the procurement of five million additional tests.”
“I warmly welcome Danaher’s commitment to provide significantly expanded access to the communities that need it most,” Peter Sands, executive director of the Global Fund, said in the press release.
“I’m very happy,” said John Green, a New York Times bestselling author and viral YouTuber who has earned a reputation as a philanthropist and philanthropist TB advocates – but he still sounded cautious.
“When good things happen, you want to celebrate,” Green said. “But at the same time, I am aware that 1.6 million people will die from tuberculosis this year.”
“It’s a human decision”
Tuberculosis is the deadliest disease in human history, killing an estimated one billion people over the past 200 years. Caused by a bacterium called M. TuberculosisTuberculosis is curable in virtually all cases and has been for 70 years, thanks to powerful tests, medications and treatments.
WATCH: A CBC report on tuberculosis from the 1990s:
But experts say drug companies are charging too high prices for critical treatments developed with hundreds of millions of dollars in public funding, excluding those who need them most.
The fact that 1.6 million people still die from the disease every year is evidence of what happens when you put profits over patients, says Green.
“The real cause of tuberculosis in the 21st century is not a bacteria,” Green said. “These are man-made systems. It’s a human choice.”
World leaders will meet in New York on Friday second high-level meeting of the United Nations on tuberculosis. Advocates and experts are hoping for promises of progress, not just from governments but also from companies.
“We can choose a world in which no one dies from tuberculosis, just as we are currently choosing a world in which 1.6 million people die,” Green said.
Tuberculosis is an airborne infectious disease that typically affects the lungs but can also affect almost any part of the body. It is estimated that one-third of people worldwide have latent tuberculosis infection, and more than 10 million are diagnosed with it each year.
Despite a cure, tuberculosis has remained the world's deadliest infectious disease almost every year since the Black Death. The only exceptions during this period were 2020 and 2021, when it took second place after COVID-19 – although the number of deaths from tuberculosis has increased.
From 2022 TB will be at the top again.
Tuberculosis typically affects those most at risk, including young children and immunocompromised people. People in poor living conditions or with little access to health care, such as in poor countries or in Indigenous communities in Canada, are also at higher risk.
“Printer ink” model for life-saving tests
But diagnosing tuberculosis is challenging. One of the few reliable methods is the use of molecular testing, said Carole Mitnick, a professor of global health at Harvard Medical School and a leading expert on tuberculosis treatment.
Part of the problem, Mitnick said, is that one multinational corporation has a virtual monopoly – namely Danaher, whose subsidiary Cepheid makes the GeneXpert molecular testing system.
Since the GeneXpert system was launched in 2006, it has been sold under the “printer ink” or “razor blade” model – that is, a company sells the base of a product at a relatively low cost (like a printer or a razor handle). ), but charges large amounts for the disposable or single-use components required (such as ink cartridges or razor blades).
The testing device, which can also diagnose HIV, hepatitis, COVID-19, Ebola and a variety of other diseases, is relatively affordable, Deborggraeve said. MSF is receiving machines that can run four tests simultaneously for $17,000 to $20,000.
Many low-income countries received them years ago when sales were subsidized by public funds, Mitnick said.
But that locks them into the GeneXpert system and forces them to buy the company's disposable TB test cartridges, which have been sold at a steep markup for over a decade.
For all tests except one, these markups continue.
Danaher and Cepheid did not respond to CBC's request for comment.
Profit margins of up to 500%
Danaher is a multinational conglomerate and holding company that reported a profit of $7 billion in 2022.
GeneXpert was developed with more than $250 million in public funding, much of which came from Canadian and US taxpayers. A Study by Doctors Without Borders (MSF). The firm, which examined public funding, concluded that “the public sector’s key role in research, development and deployment contrasts with the public sector’s inability to ensure affordable prices.”
The company has long refused to provide information about the costs of producing the TB test cartridges. In 2018, MSF commissioned an independent analysis That concluded that producing each cartridge in the quantity required in 2018 costs about $3 to $4.50.
In their statement this morning, Danaher claimed that they would sell the base TB cartridges for $7.97 at cost.
For decades, Danaher has sold them to impoverished countries and organizations that provide treatments in those communities for $10 to $15 apiece, a markup of 250 to 500 percent. At this price level, comprehensive molecular testing is out of reach for many countries with the highest TB burden.
The experts CBC spoke to said the number of cartridges sold has increased dramatically since the study was conducted in 2018, meaning production costs are likely even lower now.
With the new pricing, Danaher now charges nearly twice as much for cartridges capable of detecting extensively drug-resistant tuberculosis (XDR-TB), even though their manufacturing costs are the same.
“It’s pure price gouging. It’s pure profiteering,” Deborggraeve said before the announcement.
Given the price reduction for just one test type, this is still the case for most of Cepheid's GeneXpert cartridges, Deborggraeve said in an interview Tuesday.
“We call on companies to be transparent about costs… so that countries don’t have to buy blindly.”